When Turkish student Yagmur Varkal found out she had to pay for a vaccine that protects her against cervical cancer, she took health officials to court for a refund – and won a landmark victory.
Buoyed by her victory last month, other women have since taken legal action to demand free access to the human papillomavirus (HPV) vaccine, which girls are already receiving in more than 100 countries, according to the World Health Organization.
Activists in Turkey hope the Ankara court ruling could set a precedent and pave the way for universal access.
“We are very happy about the result. Our legitimate cause has been upheld,” said Varkal, 24, whose legal fight was supported by campaign group Children and Women First Association.
“But we will not stop, our main goal is to ensure that the vaccine is available for all girls and boys,” Varkal told the Thomson Reuters Foundation.
The Health Ministry did not immediately respond to a request for comment on Varkal’s case.
HPV is one of the most common sexually transmitted diseases and usually causes no symptoms and goes away on its own. However, the virus can cause cervical, throat and penile cancer in women and transgender men.
Cervical cancer is the fourth most common type of cancer in women worldwide, claiming around 1,250 lives in Turkey every year.
Vaccinating girls against HPV can reduce cervical cancer cases by about 90%, studies have found, prompting a growing number of countries to offer free vaccinations – most commonly for girls aged nine to 14, when they are most effective are.
But Turkey, which has a population of more than 84 million, has yet to add the HPV vaccine to the list of vaccinations it is providing free of charge.
At the same time, economic woes that have pushed inflation to 20-year highs and the currency, which has halved against the dollar over the past year, have made personal payment less affordable for many.
At 2,372 Turkish liras ($160) — more than half the monthly minimum wage after the currency collapse — the vaccine is too expensive for most Turkish women and girls.
Access to HPV vaccines varies by region. They are routinely provided in 37 of the 53 countries in the WHO European Region, which includes Turkey.
Greece, Armenia and others are paying full vaccination costs, while residents of Ukraine, Azerbaijan, Lebanon and Iran have to pay for their own vaccines, according to data from the HPV Information Center, an information hub co-led by the International Agency for Research will on cancer.
Candan Yuceer, a Turkish doctor and MP, estimates that less than 1% of Turkish women and girls are vaccinated against HPV.
“This relationship means that [vaccination] does not exist. It is unacceptable to ignore these deaths when thousands of lives could be saved,” Yuceer said.
Conservative social values are also a barrier to wider access to vaccinations in Turkey, where public talk about sex or women’s health is usually considered taboo, women’s activists said.
Zeynep, a 36-year-old woman from Istanbul, said she felt “angry, scared and upset” after contracting HPV because there was a social stigma attached to STDs.
“Coming from a conservative family, I blamed myself,” said Zeynep, who asked not to be called by her real name.
But after talking to friends, Zeynep found that many of them had the virus as well.
Activists say Varkal’s March 10 victory in an Ankara court over the state’s Social Insurance Institution, which funds health care including vaccines, sets an important precedent that could eventually lead to widespread access to the HPV vaccine.
More than 25 women have petitioned Turkish courts for their own refunds in a class action lawsuit supported by the Children and Women First Association, which has also worked with pharmacists campaigning for free vaccinations.
“We have only one goal left: the politicians must decide to include the HPV vaccines in the national vaccination program,” said Cem Kilic, a pharmacist who is leading the free vaccination campaign.
Nilda Baltali of the Children and Women First Association said women will continue to be at higher risk of cancer until the vaccine is made available free of charge.
“Our efforts are aimed at the right to life,” she said.